Tuesday, September 28, 2010
Is A Back Door Being Built For A Single Payer System?
That question is considered in the guest post that was provided below by a DMCB physician-colleague.......
From my perspective as a solo family doctor it looks that way to me.
I am seeing some disturbing changes in how physicians bill for their services, the rise of insurance mandates and increasing consolidation of the health insurance industry. Carried to their logical conclusion, the government will need to step in. Maybe that's the intent.
My daughter recently had an appointment with her pediatrician for a “well-child” visit. When I received a copy of the physician’s bill, I noticed that there was a fee for the well visit as well as for an intermediate acute visit (99213). This is important because my family insurance uses a high deductible policy. When I brought the possibility that there may be overbilling to the attention of physician’s office, they claimed it was well within coding guidelines.
I didn’t agree, so I asked for a copy of the physician’s office note. This was enough to have my inquiry referred to the physician’s coding and compliance officer. After reviewing my daughter’s chart, he agreed that it did not meet requirements for a 99213 intermediate visit and informed me that the account would be credited.
This is more important than now being able to enjoy a night out with my spouse. That pediatrician’s practice was recently acquired by a hospital that is positioning itself to become an “Accountable Care Organization” (ACO). Before the hospital owned the pediatrician's practice, it was unheard of it to bundle a well and acute visit. But now, the hospital has apparently launched an aggressive coding initiative that is designed to maximize revenue. I predict that future ACO’s will find this and other ways to maximize revenue in ways that would have never been considered by well-meaning physicians and policy makers. This will increase costs.
In the news, I hear that some are calling the individual insurance mandate unconstitutional. They are trying to strike this provision from “Obamacare”. If this is taken out without modifying the other provisions (i.e. dealing with preexisting conditions ), there is evidence that this will bankrupt insurance companies or cause skyrocketing premiums.
Government mandates for coverage without regard for actuarial consequences will also cause premiums to dramatically increase. In Pennsylvania we now have an autism mandate for enhanced coverage to care for autism patients. Any enhanced or generous coverage for any specific disease process has the ability to bend the cost curve in the wrong direction. This will also increase costs.
Lastly, insurance company mergers and acquisitions have been commonplace in the last decade. If oligopolies occur (and by many accounts they already have) prices will go up and the government may be inclined to enact anti-trust protections, further increasing the involvement of government in health care.
Taken together, these developments and others may ultimately open up a back door for the single payer system. The combination of aggressive clinical billing, expanded disease coverage without universal coverage and insurance oligopolies may set the stage for increased government intervention backed by a frustrated voting public.
The most worrisome aspect is that the government may be as dumb as a fox. It is well known that the Obama Administration is enamored with increased federal involvement of healthcare. Between navigating the health care system for myself and my patients, watching the news and following the political dramas, it sure looks as if the stage has been set for the eventual passage of a single payer system.